Physician Japanese Red Cross Nagoya Daini Hospital Inazawa, Aichi, Japan
Background: Intraventricular hemorrhage (IVH) is a risk factor for adverse neurodevelopmental outcomes in extremely preterm infants (born at less than 28 weeks gestation). In addition to its established risk variables , such as immaturity, inflammation, and ischemia–reperfusion, recent studies highlight excess sodium and fluid intake as a potential cause of IVH . Objective: To clarify the role of fluid intake on the development of severe IVH in extremely preterm infants, we conducted a retrospective observational study. Design/Methods: Subjects: We included 141 extremely preterm infants who were admitted to a tertiary neonatal intensive care unit from May 2010 to December 2020. Of these, 129 in-born infants were assessed, excluding two infants with twin-to-twin transfusion syndrome and one infant with major malformation syndrome. Methods: Fluid administration per body weight (IN)(ml/kg/day), fluid excretion per body weight (OUT) (ml/kg/day), and fluid balance (BAL) (ml/kg/day) were calculated for 0–24, 24–48, 48–72, and 72–96 h after birth. The primary outcome was the composite outcome of death or the development of grade III/IV IVH after 24 h of age. Generalized estimating equations were used to assess the relationship between the fluid management and the composite outcome of death or the development of grade III/IV IVH after 24 h of age by taking the bias of mandatory covariates and intra-individual repetitions into account. Results: There were 26 cases of severe IVH and 21 deaths during hospitalization. Fluid intake within 24 h of life was associated with adverse outcome, with an odds ratio of -0.018 (95% confidence interval, -0.031 to -0.005) (adjusted for gestational age and 5-min Apgar scores).
Conclusion(s): Excessive sodium intake has been linked with IVH in extremely preterm infants. In this study, fluid intake within 24 h of age was associated with the development of severe IVH after 24 h of age. Further studies are needed to confirm whether fluid administration or sodium intake is associated with the development of severe IVH.
